Filler Complication: When It's Not Hyaluronic Acid, More Hyaluronidase Won't Help
劉達儒醫師 · 7/30/2026
This is a true case of a filler complication after treatment at another clinic; details have been de-identified.
After receiving filler injections, she developed a rare complication. The injection site was intensely painful, and the pain persisted for several months.
Everyone told her the same thing: "It's just hyaluronic acid; hyaluronidase will dissolve it." So, she underwent round after round of hyaluronidase injections at other clinics. Some of it dissolved, but the pain didn't lessen at all. For months, no one could give her a definitive answer.
The answer appeared in my consultation room the moment I placed the ultrasound probe. What was in her face was not hyaluronic acid at all, from beginning to end.
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When she walked into the consultation room, her mid-face was only slightly swollen, almost imperceptible upon a quick glance. She said that ever since the mid-face injections, her face had been in pain every day. The pain radiated to her facial nerves, to her teeth, and all the way to the back of her head. She tried painkillers, anti-inflammatory drugs, and antibiotics, but nothing could suppress it. Eventually, she needed medication typically prescribed for neuropathic pain to barely keep the discomfort at bay.
The swelling was recurrent, sometimes subsiding, sometimes flaring up again. The pain never stopped. Among filler complications, this kind of persistent, "shadow-like" pain is not something I see frequently. The extent of her pain was evident in what she was willing to consider: she was prepared to have the affected area surgically removed, solely to stop the pain.
Endless Hyaluronidase
She was very cooperative and truly dedicated. At other clinics, she had undergone numerous hyaluronidase treatments. Some were even performed under ultrasound guidance, with the needle tip precisely delivered to the visible target. She mentioned that it did feel a bit softer after the injections, but several lumps simply wouldn't dissolve, no matter how much hyaluronidase was injected. Even when the enzyme was delivered directly into the capsule, those lumps remained in place. Eventually, almost every conceivable area had been treated, yet the pain reported punctually every day.
When a treatment repeatedly fails, the diagnosis should be the first thing to be questioned.
Two Paths Leading to Surgery
She also underwent further CT imaging. The scans revealed small subcutaneous nodules and signs of fibrosis. Subsequently, she received two surgical recommendations.
The first involved an external incision near the lower eyelid (for eye bags), using this opening to clear out the material inside. However, the same recommendation also stated that the deeper portion would be very difficult to access and clear.
The second involved an intraoral approach, dissecting through tissues and nerves, pushing deep to reach the affected area, and then excavating the material.
I first discussed the risks with her. The oral cavity is a non-sterile environment, and entering through this pathway carries a significant risk of infection. If an infection were to occur, her current condition would only worsen. The nerves along the path are also not something that can be simply pushed aside. She listened, nodded, and then said she still wanted to proceed. To her, at this level of pain, surgery was already a viable option.
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I arranged an ultrasound for her. The moment I placed the probe, I was astonished.
What was beneath her skin was not hyaluronic acid. It was, in fact, another type of filler—a product designed to stimulate collagen production, which naturally does not respond to hyaluronidase. Yet, the version she had been told was "large-molecule hyaluronic acid" from beginning to end.
Months of medication.
Countless hyaluronidase injections.
Two surgical recommendations ready to be signed.
All based on a mistaken product name.
Why the patient was given the wrong name remains a mystery to me.
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Her material did not need to be surgically removed. Without resorting to surgery, my long-standing approach involves ultrasound-guided pinhole extraction, a minimally invasive removal through a single pinhole incision. The actual amount that can be reduced depends on the location, extent, and degree of fibrosis. Reducing the source doesn't guarantee that symptoms won't recur, but at least this time, we were addressing something that genuinely existed.
The most costly aspect of this case wasn't the months of medication. It was her diligent effort at every step. She cooperated with treatments. She underwent imaging tests. She was even willing to accept surgical risks. Her effort was not the problem; the direction was fundamentally flawed from day one. A single piece of incorrect information—the product name—led her down an entirely wrong path.
We often treat informed consent as merely the paper signed before a procedure. What that paper truly protects is whether you have been given the correct name of the product. In this industry, material names are often used as marketing language. Attractive aspects are clearly articulated, while explanations for complex details are vaguely glossed over.
You have the right to decide whether or not to receive an injection. The prerequisite is that someone must first tell you exactly what is being injected.
Camus, in his commentary on the philosopher Brice Parain, wrote:
"To misname things is to add to the world's misfortunes."
I want to ask everyone: Can you state the correct product name of the filler you currently have in your face? If not, what exactly did you consent to in the first place?